Kabongo Jacqueline, Mudawarima Louisa, Majo Florence D, Dzikiti Anesu, Tome Joice, Chasekwa Bernard, Mutasa Batsirai, Dzapasi Lloyd, Munetsi Epiphania, Cordani Isabella, Ntozini Robert, Langhaug Lisa F, Bwakura-Dangarembizi Mutsa, Prendergast Andrew J
Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
Matern Child Nutr. 2025 Jan;21(1):e13726. doi: 10.1111/mcn.13726. Epub 2024 Sep 13.
Children hospitalised for severe acute malnutrition (SAM) have a high risk of mortality, relapse and rehospitalisation following hospital discharge. Current approaches fail to promote convalescence, or to address the underlying social determinants of SAM, meaning that restoration of long-term health, growth and neurodevelopment is not achieved. Although guidelines recommend play and stimulation to promote recovery, most caregivers are not supported to do this at home. We set out to evaluate the feasibility and acceptability of a codesigned intervention package aimed at providing child stimulation through play, and strengthening caregiver capabilities through problem-solving skills, peer support and income-generating activities. We evaluated the intervention in two phases, enroling 30 caregiver-child pairs from paediatric wards in Harare, Zimbabwe, once children who had been hospitalised with SAM were ready for discharge. Children were median 17.8 months old, and 28.6% had human immunodeficiency virus. Trained intervention facilitators (IFs)-lay workers whose own children had previously had SAM-delivered the intervention over 12 weeks with nurse supervision. Qualitative interviews with caregivers and IFs showed that the intervention was feasible and acceptable. Participants reported benefiting from the psychosocial support and counselling, and several started income-generating projects. Caregivers appreciated the concept of play and caregiver-child interaction, and all reported practising what they had learned. By Week 12, caregiver mental health and caregiver-child interaction improved significantly. Overall, the intervention was feasible, acceptable and showed promise in modifying caregiver knowledge, attitudes and practice. An efficacy trial is now needed to evaluate whether the intervention can improve child convalescence following complicated SAM.
因重度急性营养不良（SAM）住院的儿童在出院后有很高的死亡、复发和再次住院风险。目前的方法未能促进康复，也未解决SAM的潜在社会决定因素，这意味着无法实现长期健康、生长和神经发育的恢复。尽管指南建议通过玩耍和刺激来促进康复，但大多数照顾者在家中并未得到支持来这样做。我们着手评估一个共同设计的干预方案的可行性和可接受性，该方案旨在通过玩耍提供儿童刺激，并通过解决问题的技能、同伴支持和创收活动增强照顾者的能力。我们分两个阶段评估了该干预措施，在津巴布韦哈拉雷的儿科病房招募了30对照顾者-儿童对，一旦因SAM住院的儿童准备好出院。儿童的年龄中位数为17.8个月，28.6%感染了人类免疫缺陷病毒。经过培训的干预促进者（IFs）——其自己的孩子曾患过SAM的非专业工作人员——在护士监督下进行了为期12周的干预。对照顾者和IFs的定性访谈表明，该干预措施是可行的且可接受的。参与者报告称从心理社会支持和咨询中受益，有几个人开始了创收项目。照顾者赞赏玩耍和照顾者与儿童互动的概念，所有人都报告称在实践他们所学的内容。到第12周时，照顾者的心理健康和照顾者与儿童的互动有了显著改善。总体而言，该干预措施是可行的、可接受的，并且在改变照顾者的知识、态度和行为方面显示出前景。现在需要进行一项疗效试验，以评估该干预措施是否能改善复杂SAM后的儿童康复情况。
